The URL can be used to link to this page

Home My WebLink About14335-Z IELll tNS1'r C '1 tuN I)AVIII III L' 1y 1J 1 . I X iN H L,J FOUNDATION ( 1st ), '.'OUNDATION ( 2nd ) 2 . ' z 0 ;TOUGH FRAME & PLUMBING ci\ • Nn ' H r .3 . 114SULATION PER N . Y. y� STATE ENERGY CODE x r C� H FINAL x ADDITIONAL COMMENTS : H V. ,C1 - H v d 1 • x r, FORM NO. 1 TOWN OF SOUTHOLD BUILDING DEPARTMENT t TOWN HALL SOUTHOLD, N.Y. 11971 J / TEL.: 765-1802 Examined . . . .6�f.�• . • • • • 19?F Received . . . .. . . . . . . . . 1 9 Pp A, roved . . . . .A)a .�. . . . . .. 19 KPermit No. J.�•S Disapproved a/c . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . (Building Inspector) APPLICATION FOR BUILDING PERMIT Date la" . . . . . . . . . . . . .. 19 �. INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted to the Building Inspector, with sets of plans,accurate plot plan to scale. Fee according to schedule. b. Plot plan showing location of lot and of buildings on premises, relationship .to adjoining premises or public street or areas, and giving a detailed description of layout of property must be drawn on the diagram which is part of this appli cation. c. The work covered by this application may not be commenced before issuance of Building Permit. d. Upon approval of this application, the Building Inspector will issued a Building Permit to the applicant. Such permi shall be kept on the premises available for inspection throughout the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to th( Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances o Regulations, for.the construction of buildings, additions or alterations, or for removal or demolition, as herein described The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and tc admit authorized inspectors on premises and in building for necessary inspections. 1 �1!S ltl eiJ &ratN ?Za .� r.�� (Signature of applicant, or name, corporation) �r (Mailing address of applicant) State whether applicant• is owner, lessee, agent, architect, engineer, general' contractor, electrician, plumber or builder Y.. . .. . .c.l! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Name of owner of premises . �/•cJ�c-^ >� �:. . (./�.r1 ".! S . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . (as on the tax roll or latest deed)- If applicant is a corporation,signature of duly authorized officer. (Name and title of corporate officer) Builder's License No. . . �. . . . . . . . . . . . . . . . ... . . Plumber's License No. . .. . . .. . . . . . . . . . . . . . . . Electrician's License No. . .�. �`� .�. . . . . . . . . . . . Other Trade's License No. ! 'I. . . . . . . . . . . . . . I 1. Location of land on which proposed work will be done. �f:�.' / ./�`'`�. `� �' r• Y ' J • • • • • • • • • • �u, •1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . House Number Street Hamlet County Tax Map No. 1000 Section . . . . . . . . . . . . Block . . . . �. . . . . • • • • • • . . Lot . . . . . • • • • • • • • Subdivision . . . . . . . .. . . . . . . . . . Filed Map No. . . . . . . . . . . . . . . Lot. . . . . . . . . . . . . . . . (Name) 2. State existing use and occupancy of premises and intended use and occupancy of proposed construction: a. Existing use and occupancy . . . �1.1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b. Intended use and occupancy ir.S.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Iftyim— t 3. Nature of work (check which applicable): New Building . . . . ... . . . . Addition . . . . . . . . . . Alteration Repair . . . . . . . . . . . . . . Removal . . . . Demolition . . . . . . . . . Other Work . (Description; 4. Estimated Cost !. rf ti3 =�ntJ, U . . . . . . ... . . . . . . . . . . . . . . . . Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . It., 'to be paid on filing this application) 5. If dwelling,number of dwelling units . . . . ./. . . . . . . . . Number of dwelling units on each floor . . . . . . . . . . . . . . If garage,number of cars 6. If business, commercial or mixed occupancy, specify nature and extent of each type of use • . 7. Dimensions of existing structures,if any: Front . . . . . . . . . . . . Rear Depth . Height . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . . . . . . . . . . . . . . Dimensions of same structure with alterations or additions: Front Rear Depth . . . . . . . . . . . . . . . . . . . . . . Height . . . . . . . . . . . . . . . . . . . Number of Stories . . . . . . . . . • . . . . 8. Dimensions of entire new construction: Front . . . . . . . . . . . . . . . RearDepth 'Height . . . . . . . . . . . . . . . Number of Stories • • • • • ' ' ' • ' ' ' 9. Size of lot: Front . . . . . . . . . . . . . . . . . . . Rear • •. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. Date of Purchase Depth . . . . . . . . . . . . . . . . . . . . . . . . . . . . s Nay of Bormpr Owner . . . . . . . . . . . . . . . . . . . . . . . . . . 11. Zone or use district in which premises are situated . A! . . . . 12. Does proposed construction violate any zoning law,.ordinance or regulation: 13. Will lot be regraded . . . . . . . . . . . Will exc�e�ss fill be removed from premises: Yes (Zi. 14. Name of Owner of premises irf �Et�i r , / ;�,.? ; , , . Address N....,k A-,.!• . vIT , •Phone No. .Y.7,7,-V 7 e' Name of Architect f .Address . Phone No. Name of Contractorf-✓, /f�:�tP t,-- , Address •5/� . . . . . . . . . S Phone No. PLOT DIAGRAM Locate clearly .and distinctly all buildings, whether existing or proposed, and,indicate all set-back dimensions froi property lines. Give street and block number or description according to deed, and show street names and indicate wheth( interior or comer lot. Y c. .t. ! �j0 v > c= G g / r" /,J /3.C< <� lclt- Wil.►2 ��✓j c->( W a c� 5' /! d c ✓ 5�'►yi � Cv[ rx 1�Gj (2-4-3-11/1p, 5 7 i �(, c� 7tLovcvL r A' {ly / may rG iJ c kl LP tl7 c' <�' J�i,rl t vt C>J. / S,t7/ 11 F._/� tcic: C' Gc�Jyl UCitU j 11l /a ir�L�.C�y� Get fi1 ��Y1L11 u'iii cX`:�.�_j /J`t fj,c'c.f )'c�c:rz� av r �1 rYlti �� 3 6 ec ! *� `c0)1 6/'L . c/c.=;,u !1 f'.;�X.� /� /�.. `,y / r y�. Y tX F�J .l j� �1Z (.c> c.:�� d/ /C' t LvJ •r' �f( !r (i�' (.l.:-• 7�c,0 11, c] i!G? �6j .: 7/ ... )r STATE OF NEW YO K, COUNTY OFr`.�. . . S.S . . , , , , , , . : t/CS*T /... .�/C_/{I7__" ' being duly sworn, deposes and says that he is the applicant (Name of individual signing contract) above named. He is the . . . . . . . . .C- o N r��(:?v/ .. . . . . . . . . . . . . . . . . . . . . . (Contractor, agent, corporate officer, etc.) of said owner or owners, and is duly authorized to perform or have performed the said work and to make and file this application; that all statements contained in this application are true to the best of his knowledge and belief;and that the work will be performed in the manner set forth in the application filed therewith. Sworn to before me this . . . ;. . . . . . . . . . . .day of{v Notary Public, . . . . . . • , , , . , • County , P- ,9-�,4 Z, 'r-�t � NOTARY die gt Nwa Yom . . . . . . . . Na.4922M,Suffolk C (Signature of applicant) Term Exptsee March So. 1 F. s` ,i; :;,,New York State ma-p not bearing s inked seal or r = se l;Ghsil not ba consib'om lis ir,diaated hews t shell run ._ t ./. .. .- ,- .. . . _ ..' �•' - ,','S ihY.p,-mor;for YdhQn1 the Survey cr �-',end on his W-half to this govemm mal£coney and . . `t e • . �� - 'Fr:i;f:C IRSlftvtiC'ri listed tm.em am 'c r',:esvpnees of tho lending{nzS- 4� Gas,srteks ore na3 trensfera'aig i*stitut;or;a or subsequent